Week 4: Health promotion (smoking, drug and alcohol abuse)

Question 1

‘Low risk’ level of alcohol consumption

Answer 1

• Men and women are advised not to drink more than 14 units a week on a regular basis
• Spread drinking over 3 or more days
  
  • 14 units is equivalent to 6 pints of average-strength beer or 10 small glasses of lower-strength wine.
• To cut down drinking have a few alcohol-free days a week

Question 2

long term risk of excess alcohol

Answer 2

• Risk of cancer e.g. mouth throat and breast
• Strokes
• Heart disease
• Liver disease
• Damage to the brain/CNS
• Diabetes

Question 3

short term risk of excess alcohol

Answer 3

• Accidents resulting in injury
• Misjudging risky situations
• Losing self-control
• Alcohol poisoning

Question 4

What advice should be given to pregnant women?

Answer 4

• Safety approach is not to drink at all
• Can lead to long term harm to the baby

Question 5

How alcohol can effect foetus

Answer 5

• Fetal alcohol spectrum disorders (less severe than FAS)
• Fetal alcohol syndrome
  
  • Restricted growth
  • Facial abnormalities
  • Learning and behaviour disorders

Question 6

Alcohol and medication

Answer 6

• The way alcohol is processed is changed by some medication
• As we get older the rate at which we process alcohol also changes
• Older adults may experience harm even if drinking within limits
• Some medication. Absolutely no alcohol is recommended
• See below for interactions and risks

Question 7

Harmful drinking

Answer 7

(high-risk drinking) is defined as a pattern of alcohol consumption causing health problems directly related to alcohol.

• This could include psychological problems such as depression, alcohol-related accidents or physical illness such as acute pancreatitis.
• In the longer term, harmful drinkers may go on to develop high blood pressure, cirrhosis, heart disease and some types of cancer, such as mouth, liver, bowel or breast cancer.

Question 8

Alcohol dependence is characterised by craving, tolerance, a preoccupation with alcohol and continued drinking in spite of harmful consequences (for example, liver disease or depression caused by drinking).

• Alcohol dependence is also associated with increased criminal activity and domestic violence, and an increased rate of significant mental and physical disorders…
• Dependence exists on a continuum of severity. However, it is helpful from a clinical perspective to subdivide dependence into categories of mild, moderate and severe.

Answer 8

is characterised by craving, tolerance, a preoccupation with alcohol and continued drinking in spite of harmful consequences (for example, liver disease or depression caused by drinking).

• Alcohol dependence is also associated with increased criminal activity and domestic violence, and an increased rate of significant mental and physical disorders…
• Dependence exists on a continuum of severity. However, it is helpful from a clinical perspective to subdivide dependence into categories of mild, moderate and severe.

Question 9

Building a trusting relationship and providing information

Answer 9

• build a trusting relationship and work in a supportive, empathic and non‑judgmental manner
• take into account that stigma and discrimination are often associated with alcohol misuse and that minimising the problem may be part of the service user’s presentation
• make sure that discussions take place in settings in which confidentiality, privacy and dignity are respected.

Question 10

In the initial assessment specialist alcohol services will help people who misuse alcohol

Answer 10

agree a goal of treatment with service user

e.g. are they going to abstene or drink in moderation

Question 11

abstinence.. appropriate for

Answer 11

• people with alcohol dependence
• people who misuse alcohol and have significant psychiatric or comorbidity

Question 12

moderation… appropriate for

Answer 12

• for harmful drinking or mild dependence, without significant comorbidity

Question 13

Interventions for harmful drinking and mild alcohol dependence

Answer 13

psychological and and pharmacological interventions can be used

Question 14

psychological intervention for alcohol abuse

Answer 14

cognitive behavioural therapies, behavioural therapies or social network and environment based therapies

→ address mental health

Question 15

pharmacological interventions for people with alcohol dependence or disease caused by alcohol

Answer 15

e.g. acamprosate

(disulfiram used less regulary now)

Question 16

people with alcohol dependence should not go

Answer 16

cold turkey

• can cause seizures

Question 17

questionnaire which screens for alcoholism

Answer 17

CAGE

Question 18

CAGE

Answer 18

This easy-to-use patient questionnaire is a screening test for problem drinking and potential alcohol problems.^[1] The CAGE questions should not be preceded by any questions about alcohol intake - ie its sensitivity is dramatically enhanced by an open-ended introduction

A score >=2 should prompt further exploration. This might include the use of other questionnaires

Question 19

serious consequences of alcohol misuses

Answer 19

Wernickes encephalopathy

Korsakoff syndrome

Question 20

Wernicke’s encephalopathy i

Answer 20

is the presence of neurological symptoms caused by biochemical lesions of the central nervous system after exhaustion of B-vitamin reserves, in particular thiamine (vitamin B1)

confusion, ataxia, visual changes

• often alcoholic given B12 (thiamine) supplements

Question 21

korsakoff syndrome

Answer 21

a chronic memory disorder caused by severe deficiency of thiamine (vitamin B-1). Korsakoff syndrome is most commonly caused by alcohol misuse, but certain other conditions also can cause the syndrome.

Question 22

alochol interaction with different drugs inc

Answer 22

• sedatives
• painkillers
  
  • paracetamol
  • NSAIDS
  • opioids
• antidepressants
• anticoagulants
• antihyperglycaemics
• anticonvulsants
• antihypertensives

alcohol and some medications can increase effect of both drugs increasing risk of overdose

Question 23

smoking and MECC

Answer 23

Ask people at every opportunity if they smoke, and advise them to stop smoking in a way that is sensitive to their needs and preferences.

• Health care professionals should opportunistically ask people if they smoke during a consultation. If the person does smoke, very brief advice (VBA) for smoking cessation should be provided.
• If a person smokes, it is important to find out about their:
  
  • Smoking behaviour.
  • Level of nicotine dependence.
  • Previous quit attempts.

Question 24

If the person smokes, deliver very brief advice (VBA).

Answer 24

• VBA is typically given in less than 30 seconds:
• Ask about current and past smoking behaviour.
• Provide verbal and written information on the risks of smoking and the benefits of stopping smoking.
• Advise on the options for quitting smoking including behavioural support, medication and e-cigarettes.
• Refer the person to their local stop smoking service (if they wish to stop smoking).

Question 25

withdrawal symptoms from nicotine

Answer 25

Question 26

Benefits to stopping smoking

Answer 26

• Increases life expectancy
• Reduces risk of heart disease and lung cancer
• Reduces harm to children
• Reduces harm to foetus

Question 27

Groups who should be strongly encouraged to give up smoking

Answer 27

• Pregnant women (including pregnant women who have stopped smoking in the past 2 weeks or who have a carbon monoxide reading of 7ppm or more)
  
  • Varenicline or bupropion should not be prescribed
  • NRT can be
• Parents of young children, especially breastfeeding women.
• Young people aged 12-17.

Question 28

what should not be prescribed to pregnant women giving up smoking

Answer 28

• Varenicline or bupropion should not be prescribed
• NRT can be

Question 29

Stop smoking help

Answer 29

• Referral to stop smoking services
• Treatments
  
  • Nicotine replacement therapy
    
    • Patches
    • Gum
    • E-cigs
  • Varenicline
  • Buproprion
• Review 2 weeks after stopping smoking- CO level measured after 4

Question 30

For people not wanting to stop smoking

Answer 30

• For people who are unwilling or not ready to stop smoking:
  
  • Ensure they understand the health risks associated with smoking.
  • Encourage them to seek help to quit smoking completely in the future.
  • Offer a harm-reduction approach to smoking.
    
    • Stopping smoking, but continuing to use nicotine replacement therapy (NRT).
    • Cutting down before stopping smoking, with or without NRT.
    • Smoking reduction, with or without NRT.
    • Temporary abstinence from smoking, with or without NRT.
    • NRT may be used as long as necessary to prevent relapse.
  • Record the fact that they smoke and at every opportunity ask them about it again in a way that is sensitive to their preferences and needs.

Question 31

If the person agrees to try a harm reduction approach, ask about:

Answer 31

• Their reasons for smoking.
• Their smoking triggers.
• Their smoking behaviour.
• Previous attempts to quit smoking.
• Their health and social circumstances.

Question 32

There are three broad groups of agents have the potential for misuse:

Answer 32

• Illegal drugs (those which are regulated by law)
  
  • E.g. cocaine
• ‘Legal highs’ (psychoactive substances not regulated by law)
• ‘Prescription only medicines’
  
  • E.g. tramadol

Question 33

Prescription medication issues

Answer 33

• May fake pain to get drugs
• May give drugs to someone else
• May sell the drugs- street value

Question 34

At risk groups

Answer 34

• Vulnerable young people (not in education, employment, prison systems)
• Homeless
• Sex workers
• Families with parents with substance issues
• Veterans

Question 35

reducing harm programmes e.g.

Answer 35

• needle exchange programmes
• drug consumption rooms
• drug testing clubs
• education
• opiate substitutions
  
  • methadone
  • buprenorphine

Question 36

What questions would you ask in history-taking from a person who uses drugs?

Staff in mental health and criminal justice settings (in which drug misuse is known to be prevalent) should ask service users routinely about recent legal and illicit drug use. The questions should include whether they have used drugs and, if so:

Answer 36

• of what type and method of administration
• in what quantity
• how frequently.

Question 37

What questions would you ask in history-taking from a person who uses drugs?

In settings such as primary care, general hospitals and emergency departments, staff should consider asking people about recent drug use if they present with symptoms that suggest the possibility of drug misuse, for example:

Answer 37

• acute chest pain in a young person
• acute psychosis
• mood and sleep disorders.

Question 38

What are “brief interventions” and how can you deliver these in primary care?

Answer 38

1. During routine contacts and opportunistically (for example, at needle and syringe exchanges), staff should provide information and advice to all people who misuse drugs about reducing exposure to blood-borne viruses. This should include advice on reducing sexual and injection risk behaviours. Staff should consider offering testing for blood-borne viruses.
2. Group-based psychoeducational interventions that give information about reducing exposure to blood-borne viruses and/or about reducing sexual and injection risk behaviours for people who misuse drugs should not be routinely provided.
3. Opportunistic brief interventions focused on motivation should be offered to people in limited contact with drug services (for example, those attending a needle and syringe exchange or primary care settings) if concerns about drug misuse are identified by the service user or staff member. These interventions should:
   
   • normally consist of two sessions each lasting 10–45 minutes
   • explore ambivalence about drug use and possible treatment, with the aim of increasing motivation to change behaviour, and provide non-judgemental feedback.

Question 39

What sources of help are available in the community? Consider NHS and non-NHS options

Answer 39

• Self-help e.g. e.g. 12 step principles used by narcotics anonymous
• A range of psychosocial interventions are effective in the treatment of drug misuse; these include contingency management and behavioural couples therapy for drug-specific problems and a range of evidence-based psychological interventions, such as cognitive behavioural therapy, for common comorbid mental health problems.